The Healing Potential of the Vagus Nerve Intrigues Researchers

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The Healing Potential of the Vagus Nerve Intrigues Researchers
Vagus NerveStimulating Peripheral Activity To Relieve ConditiNeuroscience
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The vagus nerve, a network of nerve fibers connecting nearly every organ to the brain, plays a crucial role in detecting and responding to bodily distress. While wellness influencers promote unproven methods for harnessing its power, scientific research increasingly reveals the vagus nerve's therapeutic potential. Studies show that stimulating the vagus nerve, either through implanted devices or external gadgets, can effectively treat epilepsy, depression, stroke, obesity, pain, and migraines. This promising field of research has attracted significant funding from the National Institutes of Health, aiming to unlock the full potential of this remarkable nerve.

The healing potential of the brain’s most interconnected nerve intrigues researchershe vagus nerve is a vine of nerve fibers with roots in nearly every organ and shoots in the brain. It helps us detect a racing heart, rising blood pressure, stomachache, discomfort, an overzealousand even alarm calls from microbes in our gut. When it senses trouble, the vagus helps to steady our heart, soothe our stomach, rein in our immune system and calm us down.

“A truly revolutionary idea can take 20 to 40 years before it’s thoroughly adopted,” says neurosurgeon Kevin J. Tracey of the Feinstein Institutes for Medical Research in Manhasset, N.Y., “at which point everyone says how we needed that all along.” The vagus vine’s power may be partly mythical, and the research on it is by no means conclusive or clear. But some scientists say it offers hope for millions suffering from complex, hard-to-treat conditions.

The VNS device currently used for epilepsy, which delivers a pulse every few minutes, is a direct descendant of Zabara’s invention. A pivotal study demonstrated that it cut the frequency of seizures by 45 percent on average after a year. It is believed to work mainly by stimulating the afferent fibers, the ones leading up to the brain.

Crucially, the downward signals of the vagus help the body regulate some of its inner activity, such as heart rate, to maintain internal equilibrium. When we encounter a threat, “fight-or-flight” hormones raise our heart rate and blood pressure while curbing activity in the gut and intestines. The vagus nerve detects these changes and reports them to the brain, providing real-time feedback. It also facilitates fine-tuning.

Efforts to use vagus nerve treatment to help people with depression took off—and then stalled. The FDA approved VNS in 2005 after several trials found that using it for a year alleviated depression in at least 30 percent of patients. Two years later, however, the Centers for Medicare and Medicaid Services announced that it would not pay for the treatment, citing insufficient evidence of efficacy. The treatment costs about $30,000 or more in the U.S., which puts it out of reach for most patients.

Bolton has had her stimulator since the summer of 2021, when she enrolled in the RECOVER trial. For 30 years she had tried every conventional treatment—psychotherapy, “tons of meds,” transcranial magnetic stimulation , and even electroconvulsive or “shock” therapy, in which electrodes on her scalp delivered electric current directly to her brain. The effects never lasted. When her son and daughter were young, she’d drop them off at school, forcing a smile and a hello, then retreat to bed.

Meanwhile the RECOVER study continues. Conway and other researchers hope its data can be used to predict who would most likely benefit from future VNS work. The study did not track inflammation, but it could turn out to be a key marker. In February 2024, researchers at the University of Montreala pilot study on people with depression who had elevated inflammatory markers. After four years of VNS, almost all of them improved significantly as their inflammation decreased.

sends signals back down the efferent pathways. These orders prompt the release of acetylcholine in the spleen, where immune cells reside. Acetylcholine prompts white blood cells called macrophages to reduce their production of proinflammatory cytokines. It may also cue macrophages in the spleen to transform so that instead of destroying infected or damaged tissues as they normally do, they go to the sources of inflammation, including the gut, and help tissues regenerate.

Neuroimaging offers some clues. Although findings vary with the type of VNS and the regimen used, stimulation of the vagus generally strengthens connections between the prefrontal cortex and the amygdala—which may lead to better control over emotions. It also boosts activity in the left anterior insula, which is associated with emotion processing.

An hour-long session of tVNS paired with a game treats only a symptom of major depression—a lack of desire and motivation. But with a condition that can be so debilitating, any improvement is welcome. A surgically implanted device is presumed to be more effective, Conway says, “because it’s attached to the nerve and sends a signal 24/7 for certain.” Imaging studies also find that implants activate more brain areas than tVNS does. Externally applied VNS has other limitations as well: devices that clip to the ear stimulate primarily afferent fibers, and ones applied at the neck may not efficiently reach the vagus nerve, which is buried deep within.

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